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Use of imagery and text that could convey reduced harm in American Spirit advertisements
  1. Meghan Bridgid Moran1,
  2. John P Pierce2,
  3. Caitlin Weiger1,
  4. Mary C Cunningham1,
  5. James D Sargent3
  1. 1Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  2. 2Department of Family Medicine & Public Health, UC-San Diego School of Medicine and Division of Population Sciences, Moores Cancer Center, San Diego, California, USA
  3. 3C. Everett Koop Institute, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth College, Hanover, USA
  1. Correspondence to Dr Meghan Bridgid Moran; mmoran{at}


Background In 2015, the US Food and Drug Administration issued warning letters to three tobacco companies regarding use of the terms ‘natural’ and/or ‘additive-free’ to describe their products, as these terms inaccurately convey reduced harm. Yet, tobacco companies engage in a variety of alternate techniques to attempt to convey the same ‘natural’ (and thus reduced harm) message. It is critical to monitor these practices to inform regulatory action.

Objective To describe the marketing techniques used in Natural American Spirit (American Spirit) ads that could convey a natural and less harmful product image.

Methods Trained coders content analysed 142 American Spirit ads from 2012 to 2016.

Results In addition to use of the terms ‘natural’ and ‘additive-free’, American Spirit ads engage in a variety of other linguistic and iconic techniques that could convey reduced harm, such as references to small, local or organic farming, eco-friendly practices, and plant, farming and other nature-related imagery.

Conclusions American Spirit ads use a wide range of marketing techniques to convey a natural product image, which could subsequently communicate reduced harm.

  • Advertising and Promotion
  • Packaging and Labelling
  • Surveillance and monitoring

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  • Contributors MBM conceptualised and lead the data collection and write-up for this manuscript. JPP and JDS contributed significantly to the conceptualisation of the manuscript, and to the study design and write up of the manuscript. CW and MCC contributed significantly to the data collection instrument and data collection procedures, and to the literature review in the manuscript. MCC contributed to the statistical analysis.

  • Funding MBM's effort is supported by National Institute on Drug Abuse (NIDA) and FDA Center for Tobacco Products (CTP) (K01DA037903, PI: MBM). This manuscript was also supported by National Cancer Institute (NCI, R01 CA172058, PI: Messer) and Tobacco-Related Disease Research Program (24RT-0036, PI: Messer). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the FDA.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Unpublished data may be made available by request.